Laserfiche WebLink
BUSINESS CERTIFICATE # <br /> THE COMMONHIF-ALTFI OF MASSACHUSFTT S <br /> TOINV OF MASIMEF <br /> DATE 0?�7 <br /> • Expiration Date: ae 00 / -I <br /> In conformity with the provisions of Chapter one hundred and ten, Section five of the General Laws, as amended, the <br /> Undersigned hereby declaie(s) that a business under the title of <br /> Business Namc/DB�Gt lJ� Ws//,A,�d'.l7il� C/orrpooraJtio(n�N�ame: is/conducted at <br /> Business Location: �D CuGp7/y�iGL �ye.� la- L— <br /> Business \Mailing Address: �lG�2CA� <br /> Business Type: Wr%Z..k/te�� Business Telephone: -77�/—Se)/ c?70 <br /> Home Phone: _7_7�1—SaL3870 Email Address: ��m�5-Yo <br /> by the following named persons: <br /> } Ovener Name Owner Residence <br /> I certify under the penalties of perjury that I, to the best of my knowledge and belief, have filed all state tax returns and paid all state <br /> taxes as required under law. <br /> gnature of authorized agent "Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> *This license will not be issued unless this certification is signed by applicant <br /> In case of emergency <br /> NAME: TELEPHONE NUMBER: <br /> .Alarm Company: <br /> "Your social security number will be furnished to the Massachusetts Department of Revenue to determine whether you have met tax filing or tax <br /> payment obligations. Licensees who fail to correct their non-filing or delinquency will be subieet to license suspension or revocation. This request <br /> is made under the authority of Massachusetts General Law,Chapter 62C,Section 49A. <br /> The Comma nvealth ofMnssac•huserrs L.�el( <br /> BA1L\STABLE ss -0 1n DATE <br /> Personally appeared before me the above-named tlk(�tt,L�[,(, 11� and made oath that the foregoing statement is <br /> true. <br /> A certificate issued in accordance with this section shall be in force and effect for four years from the date of issue and shall be renewed <br /> each four years thereafter so long as such business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed� � <br /> 1t.• SEAL- JOSEPH L.MA �,° Notary Public <br /> C�MWNIr <br /> OEICIW75.X119- <br />